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ePOSTER

Abstract Title

Developing a model for global health medical education: applying learning theories to teaching in resource-poor settings

Authors

Johnstone
Batty
Lee

Theme

International Dimensions

INSTITUTION

Hospital for Sick Children, Department of Paediatrics, University of Toronto
Department of Family & Community Medicine, University of Toronto
Mount SInai Hospital, University of Toronto

Background

Global health (GH), and interest within medicine in partnering with resource-poor areas (RPAs), has dramatically increased over the last few decades including:

•Increased medical trainees’ interest in spending parts of their training in RPAs

•Institutions developing residency training streams in GH

•Institutions partnering with RPAs to provide education and clinical care(1).

Little scholarship has been done in global health medical education (GHMEd) regarding how teaching principles should be applied in RPAs.

As practices of inter-regional education become more widespread, there is an impetus to look at theories of education to see how they can be modified for application in resource poor settings.

The purpose of this work is to amalgamate theories of learning in medical education and of cross cultural teaching with experience in resource poor areas and technology use in GH to create a novel model of education for two purposes:

1. to be applied when teaching in RPAs

2. for use as a framework to build evidence and create discussion around best practice in GHMEd.

Summary of Work

Take-home Messages

Theories of education should be modified when applied in global health partnerships.

Using this new model can frame a process for education in resource-poor settings

This new model has the potential to act as a catalyst for a discussion in best practice for Global Health Medical Education.

References

(1)Balandin S, Lincoln M, Sen R, Wilkins DP, Trembath D. Twelve tips for effective international clinical placements. Medical Teacher 2007;29(9-10):872-877.

(2)Chapman A. SWOT Analysis Template. 2005-08; Available at: http://www.businessballs.com/swotanalysisfreetemplate.htm. Accessed 03/05, 2013.

(3)Evert J, Stewart C, Chan K, Rosenberg M, Hall T. Developing Residency Training in Global Health: A Guidebook. San Francisco: Global Health Education Consortium; 2008.

(4)Kauffman DM. ABCs of learning and teaching in medicine: applying educational theory in practice. British Medical Journal 2003;326(7382):213-216.

(5)Knowles MS. Introduction: the art and science of helping adults learn. In: Knowles MS, editor. Andragogy in Action: Applying modern principles of adult learning San Francisco: Jossey-Bass; 1984. p. 1-20.

(6)Gill D, Parker C, Richardson J. Twelve tips for teaching using videoconderencing. Medical teacher 2005;27(7):573-577.

(7)Ofori-Dankwa J, Lane RW. Four approaches to cultural diversity: Implications for teaching at institutions of higher education. Teaching in Higher Education 2000;5(4):493.

(8)Overman S. Mentors Without Borders. HRMAGAZINE 2004 Mar 2004;49(3):83-86.

(9)Schön DA. Educating the reflective practitioner : toward a new design for teaching and learning in the professions. 1st ed. -- ed. San Francisco, Calif.: Jossey-Bass; 1987.

Conclusion

Summary of Results

Theories in Medical Education:

Medical education has a wealth of theories available that can be applied to GHMEd.

•Adult Learning Theory may be useful to encourage long-term learning when preceptors not on site.

Adult Learning Theory may need careful planning for integration in some teaching cultures.

•Self-reflection is useful for trainees and instructors working in novel situations

•Evaluation must be tailored to specific learning culture, medical specific circumstances, and include evaluation of programme and instructor relevance.

Theories of Cross Cultural Teaching:

In many circumstances, teaching in RPAs occurs by preceptors from relatively resource-rich settings with different medical and social cultural settings.

There is an argument for preceptors to use the ‘diversimilarity’ paradigm, placing equal emphasis on similarities and diversity between medical cultures.

Using this technique, instructors discuss practice similarities between locations balanced with focus on divergences in practices.

Best Practice in Global Health Medical Education (GHMed):

The term GHMEd is defined as:

The process of inter-cultural educational partnerships occurring between instructors from resource-rich areas and students from resource-poor areas

Currently, the vast majority of literature related to this field focuses on ethical and educational principles for preparing health care workers from the ‘global north’ to work abroad.

There is also great work being done in education to support programs aiming to create residency streams in global health.

There is little focus, however, on how to alter our clinical practice (although to mention that we certainly should) and even less so on how to alter educational practice.

Technology Use for Teaching in Resource-Poor Settings:

The nature of many partnerships in GHMEd is that clinician educators from resource-rich settings visit companion sites for brief periods.

•Preceptors may stay for extended lengths of time or return frequently

•Commonly visits are short and/or taken by a different people.

Helping to counter this potential lack of continuity in teaching and mentorship is the use of technologies

• Allow more frequent communication for mentorship

•Can be used to give lectures or supervise others

•Portable devices may be brought to the bedside

•Effective use of teleconferencing in teaching has been demonstrated.